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Posted Tuesday, August 28, 2012

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This is my story: I went to my gynaecologist 7 weeks ago and after the examination I accidentally stucked my hand to a bowl were they kept all the used gynaecological instruments, not needles or sharp objects. I had a small superficial cut on my hand that was not even bleeding. I did not notice any blood or other body fluids on my hands and I washed them immediately with soap. To be honest I noticed the cut later when I got back home so this tells you it was not a big wound.

My doctor told me that there was no concern but he ordered hiv and hep tests. They took the first set of tests right after the incident and everything was OK. Then the doctor said I could get second tests 6 weeks after and after that no more testing is needed. Well, I did what the doctor told me and got tested on Tuesday. Other tests were OK but when I heared that my HIV test was negative I found out that the 4th. gen. ELISA test had been reactive. Not positive but close to the detection line. They had sent it to another lab where they did 4 additional test to it including the Western Blot. The another ELISA had also been reactive but the separate antibody, p24-test and Western Blot had been negative.

Now I am in panic! Is it really possible that I have got HIV from this incident? Why was the ELISA reactive? Is it because it is too early to find the antibodies after 6 weeks? All these questions are running inside my head. The doctor said there is nothing to worry about but I can't stop thinking what if... I have a small child and I have been breast feeding her because the doctor told me it's OK and there is no risk. I am so scared not only for my own sake but also for my little girl!!! Does anybody know has there ever been such reported cases as mine? I know that you can get hiv from blood/body fluids to a broken skin so am I at risk now and should I keep testing? Should I stop breast feeding even though the doctor said there is no need for that? Please answer!!!

First up relax. There is no risk of HIV infection from what you describe and your test results prove it.

ELISA tests can return "reactive" results for a number of reasons other than HIV infection. The much more specific and sensitive Western Blot test confirms your negative result in this case. The rule is:

Positive or reactive ELISA + Negative Western Blot == HIV negative.

Western Blot trumps the ELISA test every time.

I would recommend that you take the time to read our Welcome Thread which contains links to our testing and transmission lessons and familiarise yourself with how HIV is and is not transmitted.

Thank you for your rapid reply! I actually have read the welcome thread (meny times) and would still like to know what kind of wound must one have to be able to catch the virus when cotact with blood or body fluids? Big wound with huge amount of blood?

I appreciate your concern in this case. Finding your hand in a bucket of used pedersens must have been icky to say the least. But after 25 years of studying the HIV epidemic we've learned that HIV just isn't transmitted that way.

HIV is a fussy, fragile virus and it demands particular circumstances to be transmitted. HIV is transmitted via:

Unprotected anal sex (receptive or insertive)

Unprotected vaginal sex (receptive or insertive)

Sharing contaminated injecting equipment (needles and/or syringes)

And in certain cases from infected mother to child in the womb

Given that, from what you describe, these don't apply in your case, we're pretty safe in concluding that this wasn't an HIV risk at all and testing wasn't warranted in the first place. Nevertheless, you have tested and your test results demonstrate that you're HIV negative for the reasons I've explained above.

Issues such as wound size and amounts of blood required are really not relevant. HIV is transmitted inside the body and doesn't tolerate hostile environments such as water filled buckets and human skin.

Really, you can accept your negative results and get on with your life. Yes, you can continue to breastfeed your daughter.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

I have to try to believe that I am negative. I just can't stop thinking why the ELISA was reactive. It has never happenned to me before not even when I got tested during pregnancy and right after this incident at my gynaecologist. Just makes me wonder why... Oh Gog, I hope they haven't told me this at all... I was so ready to put this all behind me and move on and to be honest I wasn't even thinking the possibility of HIV, I was more scared of hep b or hep c that can be transmitted much more easier than HIV...

Honestly Mum, you're not HIV positive. Really. The WB result is an absolute, rock solid guarantee of it. When it comes to HIV we really know our stuff and I promise that we'd tell you if we thought you were at any risk.

All sorts of things can cause a false positive ELISA - which is why they are always double checked with the WB.

You were right in worrying more about hepatitis, although this was also very unlikely in your situation. You need to remember that cuts start to heal immediately. The skin is a wonderful organ and its first priority is to protect us from pathogens in the environment. The cut you describe as superficial would not have exposed the underlying layers of dermis and so you would have been protected by virtue of the skin's layers of protection. The skin really is a fantastic organ.

Not only that, but hiv is very fragile and does not remain in a viable and transmissable state when it finds itself outside the human body and in the environment. Even if you had a substantial cut, you would not have been at risk for hiv in this incident.

Now relax and enjoy the baby. She'll be a moody teenage before you know it so enjoy the cuddles and breastfeeding while it lasts! Don't waste your time worrying about something you could not and do not have.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Thank you so much for your reassuring answers! You are wonderfull people helping others like this! I just have to believe my negative result now. I decided to talk with my doctor on Monday and she can explain all the lab results to me. BTW. Do you know how common it is to get false positive/reactive on ELISA? Does it happen often? I found something like 1/20 000 so if this is true, I've had such a bad luck this time.

False positive results on ELISA tests are uncommon, nevertheless as you've discovered they do happen and when it does it's understandably distressing. HIV is a big deal and it's natural that people want to be certain of the results of their tests.

I think it's good that you're going to discuss this matter with your doctor in some detail. Remember that the key result here is your negative WB test. That's the deciding factor. It renders the ELISA result void in your case.

Ann pegged it with her comment on your pregnancy. Pregnancy itself is considered a non defined autoimmune condition and results in increased antibody production which can occasionally result in a false positive ELISA. A specific type of antibody is produced as a result of pregnancy and birthing that can cross react with an ELISA for several months post delivery.

It wasn't surprising to learn your western blot was non reactive and your HIV results should have been reported as negative, reflective of your actual negative status.

You can discuss alloantibodies with your physician but in the meantime rest assured that you did not acquire HIV as a result of this incident.

Thank you for your answers! I try not to think about it but I just can't help myself...

Do you experts know that can vaccinations cause false positives? I've had two hep b vaccination after this incident as prophylaxis against hep b, second shot little bit over a week before this test. I think that my pregnancy can't cause the reactivity because my child is nearly one year old now.

Can you also educate me a little: What kind of a situation would be a risk to catch HIV when having a wound? It is said that if your skin is broken and you get blood or other body fluids on it, it's possible to become infected. Does this mean that you should have a huge bleeding wound and someone pouring fresh HIV positive blood to it? Does it mean that it would never happen without noticing it?

Does this mean that you should have a huge bleeding wound and someone pouring fresh HIV positive blood to it?

Yep, Scared, that's pretty much it! It's mainly something to worry about if you, for instance, come across a car accident and try to help the victims and get cut on the wreckage yourself and then get covered in the (hiv positive) victim's blood. Not exactly an everyday occurrence.

I don't recall ever hearing of hep B vaccinations causing false positives. Autoimmune diseases are usually the culprit, but there can be other factors involved. You might want to speak to your doctor about this.

At the end of the day, what you really need to keep in mind is that you ARE hiv NEGATIVE. Period, end of story.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

I'm back again...unfortunately. I just can't get this out of my head. I spoke to my doctor and She said I need new tests at 3 moths mark. Then I called the HIV/AIDS center here and they said I do not need more tests because you just can't get hiv the way I described.

I don't know what to think. The doctor said that there is never 100% when it comes to medicine. I found out that they actually didn't do WB to my sample. They told they did a set of 4 different tests with different methods and based on that they gave the negative result. They told me that because my result was so close to reaction limit (1,2 and limit is 1,0) WB was not good test because it's specific but not as sensitive as screening tests.

I'm so worried and scared that the first test they did was correct and I really have HIV. I've read that in heathcare setting some people have become infected via wound or cut. It's very uncommon but it has happenned couple of times. Does it mean that blood from a patient has splashed directly to a open cut of a heathcare worker? There was 5-10minutes between the previous patient and my incident so would it fall in different category based on that?

Sorry to bother you, won't happen again. And sorry that I am scared for becoming infected and for transferring the infection to my little girl via breastfeeding. It's just very confusing to receive such a different information. Well it's not you problem so sorry again!

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts